RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
Mr.RAMASAMY.M
M Sc. NURSING, 1st YEAR
COMMUNITY HEALTH NURSING
YEAR 2011-12
NATIONALCOLLEGE OF NURSING
BANGALORE
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / Name of the Candidate and Address / MR.RAMASAMY.MI year M.Sc, Nursing,
NATIONAL COLLEGE OF NURSING, HEGGANAHALLI CROSS, SUNKA
DAKATTE ROAD, VISHWANEEDAM POST , VIA MAGADI ROAD, BANGALORE-560091
2. / Name of the Institution / NATIONAL COLLEGE OF NURSING
BANGALORE-560091
3. / Course of Study and subject / M.Sc. (Nursing)
COMMUNITY HEALTH NURSING
4. / Date of Admission Course
5. / TITLE OF THE STUDY / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAM ON KNOWLEDGE OF MOTHERS REGARDING DENTAL HEALTH PROBLEMS IN CHILDREN IN SELECTED AREA AT BANGALORE”
6. BRIEF RESUME OF INTENDED WORK
6.0INTRODUCTION
Even pearls are dark before the whiteness of his teeth. ~William R. Alger
Oral hygieneis the practice of keeping themouthandteethclean to prevent dental problems, especially the commondental cavitiesandgingivitis, andbad breath. There areoral pathologicconditions in which a good oral hygiene is required forhealingandregenerationof the oral tissues. These conditions includedgingivitis,periodontitis,dental traumassuch assubluxation,oral cysts, and afterwisdom toothextraction.1
Children with disabilities and special needs are at a higher risk of health problems. Special needs children need extra help to achieve and preserve physical health, including dental health. A clean mouth is the most essential requirement for good health. Children with special needs have enough problems without having poor health due to poororal healthadding to their other life problems.Special needs children are those who have special requirements due to developmental, physical, emotional or behavioral conditions who need help from caregivers and associated services.
Common oral problems such as tooth decay or gum diseases put all children and adults at risk for other health problems. However, special needs children often have more oral health problems than the general population. For instance, children with disabilities may have problems with mobility, behavioral problems, neuromuscular problems, cognitive problems, gastroesophogeal reflux problems, or seizures. These problems may make it impossible for disabled children to tend to their own oral care, which puts them at risk for tooth decay, gum disease, and other health problems.
It is possible to spread germs to your children's mouth, so remember never place anything from your mouth into your child's mouth. As a parent of a special needs child, you will be responsible for helping the child brush his teeth. Your special needs child may not beable to assist at all in oral care, so it would be your responsibility to provide him with the care he needs.
Never leave your special needs child (or any child) lying down with a bottle, or propped with a bottle. Milk, formula or any other liquid, other than water, can collect in the mouth of a resting child and cause bacteria to form in the mouth. Aside from that, there is a risk of aspiration when the child is lying down with a bottle.
Another thing to remember is that good nutrition is good for the mouth and the body, and poor nutrition can be detrimental to them. Soda, candy, sweet drinks and other concentrated sweet foods may cause cavities.2
However, million of individuals suffer from dental caries and periodontal disease, resulting in unnecessary pain, difficulty in chewing, swallowing, speaking and increased medical costs. Untreated oral diseases in children frequently lead to serious general health problems, significant pain, interference with eating and lost school time.3
Tooth decay is the most common chronic disease of childhood, affecting 50 percent of children by middle childhood and 70 percent by late adolescence.Chronicgingivitis is also common among children. Gingivitis is often casued by inadequate oral hygiene which leads to plaque buildup. Most oral diseases can be preventad.4
6.1 NEED FOR THE STUDY
School health service is a personal health service which is an economical and powerful means of reaching student community health. It has developed during the past 70 years. It has undergone several changes from the narrow concept of medical examination of school children to the present day broader concept of comprehensive health care and well being of children.5
Oral health is an integral part of general health and essential for quality of life for children. In light of the current oral disease pattern in Asia, national authorities in health and education should ensure the implementation of systematic school health programmes for promoting oral health and general health in children, based on an approach of the World Health Organization’s Health Promoting Schools Initiative. Such programmes should focus on promotion of health and include oral health care services according to the socio-cultural conditions of the country. Participants of the 2nd Asian Conference of Oral Health Promotion for School Children reaffirm the declaration of the 1st Conference in Tokyo in terms of regular exchange of information with the aim of improving the oral health status of school children.6
India, a developing country faces many challenges in rendering oral health needs. The majority of Indian population resides in rural areas, of which more than 40% constitute children. These children cannot avail dental facilities due to inaccessibility, financial constraints and stagnation of public dental healthcare services. This entails the health professional to adopt a more practical approach to achieve primary prevention of oral diseases. The most viable solution seems to be dental health education. Documented evidence shows that teachers and parents can augment dental health behavior. 7
Table – I
Incidence of Children with Dental health problems according to W.H.O (2009)
Country / Incidence (Children)India / 1,300,000
USA / 7,960,000
UK / 1,970,000
Canada / 1,330,000
Japan / 1,96,000
Table –2
State / Incidence (Children)Karnataka / 679,000
Tamilnadu / 378,000
Maharashtra / 45,600
Andhrapradesh / 9,260
Uttar Pradesh / 1,720
Incidence of children with dental health problems in India according to W.H.O(2009)
The survey is based on WHO, 1999 Oral Health Assessment, which has been modified by including gingival assessment, enamel opacities/ hyperplasia for 5 years. Evaluation of the oral health status of children revealed, dental caries is the most prevalent disease affecting permanent teeth, more than primary teeth and more in corporation than in private schools, thereby correlating with the socioeconomic status. It may be concluded that the greatest need of dental health education is at an early age including proper instruction of oral hygiene practices and school based preventive programs, which would help in improving preventive dental behavior and attitude which is beneficial for life time.7
6.1.1 STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of structured teaching program on knowledge of mothers regarding dental health problems in children in selected area at bangalore”
6.2 REVIEW OF LITERATURE
A study was Conducted to assess the oral hygiene practices, current use of and knowledge about fluoride toothpaste among schoolchildren, parents, and schoolteachers. to describe the attitudes of parents and schoolteachers in relation to improving schoolchildren's oral health. 1,557 schoolchildren, 1,132 parents, and 352 schoolteachers were recruited by multistage stratified sampling procedure. The percentage of schoolchildren, parents, and schoolteachers who actually used fluoride toothpaste was 88%, 86%, and 87%, respectively, and 74-78% of the respondent groups brushed their teeth twice a day or more. 64% of schoolchildren, 73% of parents, and 74% of schoolteachers confirmed the caries preventive effect of fluoride toothpaste. Toothpaste recommended by oral health professional organizations was preferred by respondents - particularly by schoolchildren when purchasing toothpaste (86%). 93% of parents and 56% of schoolteachers recognized their important role in promoting children's oral health; however, their lack of knowledge seemed to be a major obstacle in fulfilling this role. The use of fluoride toothpaste in Beijing appears to have increased during the past decade. In addition to mass communication comprehensive school-based oral health programmes are needed to continuously promote the use of fluoride toothpaste among schoolchildren.(8)
Astudy was conducted to assess the knowledge levels of physical education teachers before and after a seminar. The seminar included clear instructions on the appropriate treatment of avulsed permanent teeth, which were appropriate for physical education teachers. The teachers completed two multiple-choice self-administered anonymous questionnaires related to immediate treatment they could provide in cases of permanent teeth avulsion. One hundred and twenty-six teachers completed the first questionnaire, 2 months before the seminar. One hundred teachers completed the second questionnaire 10 months after the seminar. Of these, 70 attended the seminar and 30 did not. Thirty-two teachers who attended the seminar had completed both questionnaires. The percentage of teachers who provided expected 'correct' answers in the first questionnaire (11% and 16%) was significantly lower than that in the second questionnaire (23% and 68%). The percentage of teachers who provided correct answers in the second questionnaire among those who attended the seminar (24% and 69%) was not significantly different from those who did not attend the seminar (20% and 66%). An educational campaign in the community with a seminar targeted towards a cohort of physical education teachers can improve the knowledge of the teachers.(9)
A study was conducted to assess the knowledge, attitude and practices of primary school teachers. A cross-sectional, questionnaire-based survey was carried out on 100 primary school teachers drawn from 10 randomly-selected primary schools. The results revealed that majority of them have a poor attitude to oral health issues. The few of them who have attended a dental clinic mostly had extractions done. It was also found that there is a need for improved knowledge of oral health disease and their prevention among the teachers for an effective school based oral health education programme. The study suggests ways in which this can be achieved.(10)
Astudy was conducted to assess the effects of that school-based oral health education programme on pupils who had completed the programme one and a half years ago. Eight experimental and six control primary schools in the same area participated in the study. Out of each school 10 children, aged 8-12-years old, were randomly selected. ANOVA with age and gender as co-variables showed statistically significantly lower (21%) habitual plaque scores among children from experimental schools as compared to those from control schools. Tooth brushing effectiveness had significantly improved among experimental children and they took longer for tooth brushing when supervised. Differences in oral health knowledge were apparent but self-reported habits pertaining to oral health were comparable between children from experimental and control schools. Study shows that the school-based OHE programme had a moderate positive effect on oral health knowledge and on habitual plaque levels and on the effectiveness of tooth brushing. The effects on caries levels and on self-reported behavior were inconclusive.(11)
A study was conducted to assess the oral health related knowledge, attitudes, behaviors and self-assessed status of primary school teachers. 195 final year teacher trainees and 239 in-service teachers.A structured questionnaire. School teachers were generally well informed and had moderate attitudes and behaviors to oral health related issues. However, a few but important deficiencies in this regard have been identified on which recommendations are presented. A substantial proportion of teachers reported having dental problems. However, the teachers had positive attitudes towards oral health education to pupils as part of a teaching curriculum. A professional support is called upon for teachers from the oral health personnel in terms of oral health education training at teachers' colleges, to prepare the teacher trainees for their future task. Study shows that In-service teachers need to be motivated to improve their awareness on sound oral health information, attitudes and behaviors. This will facilitate their role as school oral health education providers.(12)
A cross-sectional Study was conducted to examine the prevalence of dental caries examination and questionnaire survey was conducted in 10 schools from West Baghdad. Questionnaire surveys were performed on 392 children. And the result shows that the mean DMFT and DF were 1.7 and 1.3. The rate of caries experience (DMFT > 0) was 62%. DMFT increased significantly with higher education of the mother, not being embarrassed to smile, missing school due to dental pain and between-meals mode of drinking. Increased sugar consumption was associated with being a boy, having mothers with low education, living in a low socio-economic area and brushing atleast once-a-day. Positive oral hygiene practices were higher for girls. It revealed that to maintain the low prevalence of caries among children by increasing awareness and promoting oral health care strategies.13
A study was conducted to assess the prevalence of dental caries in 6, 9, 12 and 15-year-old school children of Chandigarh, and it was evaluated using Moller's criteria (1966) and correlated with the various risk factors. The mean deft was found tobe 4.0 +/- 3.6 in 6 year old and 4.61 +/- 3.14 in 9 year old, whereas the meanDMFT in 12 and 15 year old was found to be 3.03 +/- 2.52 and 3.82 +/- 2.85 respectively. The high prevalence of dental caries in these children was attributed to the lack of use of fluoride toothpaste (80% children), lack of knowledge about etiology of dental caries (98%) and frequency of sugar exposures up to more than five times per day (30%).14
The present study was to describe theoral healthenvironment in preschoolchildrenand to examine the extent to which paired twins experience the sameoral healthenvironment.In collaboration with The Medical Birth Registry of Norway (MBRN) 100 twin families who participated in the Norwegian Mother andChildCohort, were invited to take part in ongoing studies onoral health. Participating twin families lived in Oslo and the surrounding counties of the capital. The age range of the participating twins was 1-8 years. A clinical examination took place at The Institute of Clinical Dentistry, University of Oslo in 2008. Theoral healthenvironment was measured in two ways: 1) Interview.Motherswere interviewed by trained interviewers aboutoral healthrelated habits of each of the twins. 2) Weekend diet log. Parents listed 84 different deserts, ice cream, sweets, cakes, cookies, fruits, snacks, and biscuits for each twin that were consumed on during the weekend. The statistical analyses comprised frequency distributions of the environmental variables and correlations between the variables within the pair of twins.The results showed a parental involvement in early tooth brushing and also an indication of tooth brushing not always being easy. Use of fluoride toothpaste started early, and two thirds of thechildrenalso used fluoride tablets. Use of pacifier was prevalent; the duration of use of pacifier and feeding bottle was relatively long. Nearly 75% of the parents indicated that they had noproblemsrelatively to the twins' meals, and 53% mentioned that the twin pairs were different with regard to meals. Nearly 70% of the kindergartens had a clearhealthprofile. The correlations varied between r = 0.45 and 1.00. Thechildrenin the present work were young, and the detailed information in this paper therefore adds to theknowledgeof parental involvement inchildren'soral health.15
The objective of this study was to exploreChildand FamilyHealthNurses' work-related experiences ofdentaldisease in youngchildren. Methods:Childand FamilyHealth21) who recruited new = Nurses (nmothersto an ongoing birth cohort study that began in South Western Sydney, Australia were invited to take part in a qualitative study. A semi-structured, in-depth interview technique was used to explore their experiences of preschoolchildoral healthand how this affects their working lives. Interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Results: The nurses considereddentalcaries to be a significanthealthissue for youngchildrenand their families. They thought that the burden ofdentaldisease in preschoolchildrenwas underestimated in disadvantaged and multicultural populations. In addition, they reported that parents were often unaware of the disease process and were ignorant of the relationship between bottle feeding anddentalcaries. Once the parents were informed about theirchild's poororal health, they had feelings of anger, despair, and guilt. Conclusions: This study highlights thatoral healthproblemsare a significant segment of thechildhealthproblemsidentified by nurses in their daily work. The nurses perceived the problem ofdentalcaries to be one of a lack of parentalknowledge, and families should be educated not only on "what" but also on "how" to feed theirchildren.16
The purpose of this study was (a) to explore whatmothersknow about promoting goodoral healthin theirchildrenand which information they need, and (b) to identify whether factors such as age, years of education, and number ofchildrenin the family affect theirknowledge.Data were collected from 105mothers/guardians (age range: 19 to 54 years) who brought achildto an appointment at a communitydentalclinic. When provided with a choice, 54mothers/guardians responded to surveys, and 61 participants asked to be interviewed. The respondents had between 1 and 9children(mean=2.48).Only 25.7% of the respondents gave correct answers to a question concerning the age at whichchildrenshould start seeing a dentist, and only 32.4% correctly answered a question about the age at which theirchildrenshould have their teeth brushed. However, the majority ofmothers(91.4%) knew that achildshould not go to bed sucking on a bottle containing milk or juice. The higher the family income was, the more the respondents knew aboutdentalcare utilization andoral health-related behavior. The more years of education the respondents had, the more they knew about the consequences of poororal health. The morechildrenthemothershad, the more they knew about preventingoral healthproblems. The more knowledgeable the respondents were aboutoral healthpromotion, the more often they brushed and flossed, and the lessdentalanxiety they had.Parents and caregivers can play an important role in preventingoraldisease inchildrenand should thus be well educated aboutoral healthpromotion. These findings point to the importance of focusing educational efforts on educating youngermotherswith fewerchildrenand/or less education who come from socioeconomically disadvantaged backgrounds.17